BED-WIN-79

Code
BED-WIN-79
Mercy ID
V-03041-01
Encounter Date
04/13/2009
Last
Bedolla
First
Winnie
DOB
09/18/1979
County
Fulton
Street
221 Woodcreek Court
City
Roswell
State
GA
Zip
30076-
Cell
(404) 704-2660
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
High school graduate

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Efrain Zamora 03/06/2007 Mother GA/USA
Fernando Quintero 01/07/2005 Mother GA/USA
Ivan Quintero 11/01/2002 Mother GA/USA
Kenya Quintero 10/15/1999 Mother w/Stepfather GA/USA
Paulina Quintero 01/06/2001 Mother GA/USA

Former Spouse 1 Information

Last
Zamora
First
David
DOB
09/27/1979
Telephone
N/A
COB
Mexico
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
YES
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana